Result card

  • EFF6a: Does Structured telephone support (STS) impact on the emergency room visit rate (disease-specific) of adults with chronic heart failure, compared to standard care without Structured telephone support (STS)?
  • EFF6b: Does Structured telephone support (STS) impact on the cardiology visit rate (disease-specific) of adults with chronic heart failure, compared to standard care without Structured telephone support (STS)? Jump to
  • EFF6c: Does Structured telephone support (STS) impact on the primary care visit rate (disease-specific) of adults with chronic heart failure, compared to standard care without Structured telephone support (STS)? Jump to
Structured telephone support (STS) for adult patients with chronic heart failure
D0023
English
Guidance Resources

Does Structured telephone support (STS) impact on the emergency room visit rate (disease-specific) of adults with chronic heart failure, compared to standard care without Structured telephone support (STS)?

Authors: Mirjana Huic, Pernilla Östlund, Romana Tandara Hacek, Jelena Barbaric, Marius Ciutan, Cristina Mototolea, Silvia Gabriela Scintee

Internal reviewers: J. Puñal, J. Gonzalez-Enriquez, H. Stürzlinger, A. Lo Scalzo, S. Maltoni

Acknowledgments: We would like to thank Ms Ana Utrobičić, MLIS, the Head of the Central Medical Library at the University of Split School of Medicine, Split, Croatia for development of systematic literature search strategy and performed search on standard medical and HTA databases.

The same methodology was used as described in section for the whole domain.

One systematic review were used to answer the question ” Does Structured telephone support (STS) impact on the emergency room visit rate (disease-specific) of adults with chronic heart failure, compared to standard care without Structured telephone support (STS)?” {Feltner et al, 2014}, as well as 7 RCTs out of 19 included in our new SR {Ramachandran 2007, Sisk 2006, Cleland 2005, Tsuyuki 2004, Galbreath 2004, DeBusk 2004, Barth 2001}; details can be found in Appendices 3 and 4.

 

Data found on the emergency room (ER) visit rate in STS group comparing with usual care were conflicting, but majority of the retrieved evidence found no significant difference in the number of emergency room visits in either group.

 

The most recent SR and HTA published by Feltner et al, 2014 { } reported that STS interventions had no effect on the rate of ER visits over 3 to 6 months (low SOE). Six STS trials provided data on ER visits at different time points and using different methods; two of them were also included in our SR { Barth 2001, Tsuyuki 2004}. Tsuyuki 2004}. Individual data of these two and of additional five RCTs included in our review are presented below.  

 

Ramachandran et al, 2007 { }, in a RCT aimed to assess 6 months role of telephonic disease management programme in improving the quality-of-life (QOL) of patients with heart failure, found no significant difference in the number of emergency room visits between the two groups.

Sisk et al, 2006 { } found no significant difference in the number of emergency room visits (total ER visit, 157 usual care group vs 147 in STS group, in follow-up period of 12 months.

Cleland et al, 2005 { } showed a significant difference in the number of emergency room visits in favour of usual care group (total ER visit, 8 usual care group vs 54 in STS group, in period of 8 months (Total/1000 days at risk (95% CI): UC= 0.5 (0.2 to 0.8) vs NTS= 1.6 (1.2 to 2.0).

Tsuyuki et al, 2004 { } presented a non-significant difference in all cause  of emergency room visits between groups (UC=69 vs STS=41, p=0.206), but significant difference in the number of cardiovascular emergency room visits (UC=49 vs STS=20, p=0.030).

Galbreath et al, 2004 { }  in a RCT with a treatment period of 18 months, showed that total and CHF-related healthcare utilization, including medications, office or emergency department visits, procedures, or hospitalizations, was not decreased by DM.

In the RCT published by DeBusk et al, 2004 { }  no significant difference in the number of emergency room visits was found: 126 out of 228 patients (55%) in the care management group made 1 or more emergency department visits for any cause compared with 132 out of the 234 patients (56%) in the usual care group. The mean number of emergency department visits in the treatment and usual care groups during the first year of follow-up was 3.2 (median, 2.0) and 3.5 (median, 2.0), respectively.

In the RCT published by Barth et al, 2001, { } no significant difference was found: none of the patients in the experimental group had any unexpected emergency department visits during the study period of 3 months. One patient from the control group had an unexpected visit to a local emergency department due to CHF.

 Details could be found in Appendix 3 and 4.

Important
Partially
Huic M et al. Result Card EFF6a In: Huic M et al. Clinical Effectiveness In: Jefferson T, Cerbo M, Vicari N [eds.]. Structured telephone support (STS) for adult patients with chronic heart failure [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali ; 2015. [cited 10 June 2023]. Available from: http://corehta.info/ViewCover.aspx?id=305

Does Structured telephone support (STS) impact on the cardiology visit rate (disease-specific) of adults with chronic heart failure, compared to standard care without Structured telephone support (STS)?

Authors: Mirjana Huic, Pernilla Östlund, Romana Tandara Hacek, Jelena Barbaric, Marius Ciutan, Cristina Mototolea, Silvia Gabriela Scintee

Internal reviewers: J. Puñal, J. Gonzalez-Enriquez, H. Stürzlinger, A. Lo Scalzo, S. Maltoni

Acknowledgments: We would like to thank Ms Ana Utrobičić, MLIS, the Head of the Central Medical Library at the University of Split School of Medicine, Split, Croatia for development of systematic literature search strategy and performed search on standard medical and HTA databases.

The same methodology was used as described in section for the whole domain.

Assessment element questions EFF6b and EFF6c, based on assessment element: D0023, were answered together:

To answer question ”Does Structured telephone support (STS) impact on the cardiology visit rate (disease-specific) of adults with chronic heart failure, compared to standard care without Structured telephone support (STS)?” 7, out of 19 RCTs were found {Barth 2001, Riegel 2002, Laramee 2003, DeBusk 2004, Tsuyuki 2004, Cleland 2005, Angermann 2012}, and one more RCT was found {Krum 2013} to answer question ”Does Structured telephone support (STS) impact on the primary care visit rate (disease-specific) of adults with chronic heart failure, compared to standard care without Structured telephone support (STS)?”. Not all RCTs were specific on cardiology visit rate nor on primary care visit rate. Six RCTs (on cardiology visit rate) found no significant difference, and one {Cleland 2005} found difference, in favour of control group. Two found a difference on primary care visit rate; one in favour of control group and one in favour of STS group {Cleland 2005, Krum 2013}. RCTs varied in follow-up duration period (3 month to 12 months period) as well in sample size.

 

Barth et al, 2001 { }, in 3 months follow-up period showed that CHF patients who received the structured nurse managed post discharge program did not have any unexpected physician office visit due to exacerbation of CHF during the time they were enrolled in the study. One participant in the control group had an unexpected visit to the physician’s office for adjustment of medications.

Riegel et al, 2002 { }, during a 6 months period, showed a non-significant difference in physician office visits (5.63±3.6 in intervention group vs 6.17±4.87 in usual care group).

Laramee et al, 2003 { }, during a 3 months period showed that no significant differences were found in outpatient and inpatient resource utilization between the groups.

DeBusk et al, 2004 { }, showed that in the 12 months, patients in both groups had an average of 3 cardiology outpatient visits, 6 internal medicine visits, and 4 non–internal medicine visits.

Tsuyuki et al, 2004, presented that in 6 months no significant difference was found in physician visits all-cause (p=0.795) or cardiovascular cause (p=0.366) between groups.

Cleland et al, 2005 { }, in 8 months period showed a higher rate of both, cardiology visit (UC=34 vs NTS=117) and primary care visit rates (UC=119 vs NTS=602) for patients in the intervention group. Authors discussed that patient contacts were evaluated only once every four months in the usual care group compared with monthly in NTS group, which may led to under-reporting of contacts in the control group.

Angermann et al, 2012 { }, during the 6 months period, showed a non-significant difference: across the entire study population, mean numbers of visits to cardiologists were 0.7±2.3 and 0.7±2.6 per patient in HNC and UC, respectively (P=0.86), and of visits to other specialists were 1.3±5.4 and 2.1±9.9, respectively (P=0.17). In HNC, this included also specialist care arranged by the INH team. Average numbers of contacts per alive patient/month, out of hospital, and under observation were 2.4±1.8 versus 2.4±2.1 (GP p=0.82), 0.1±0.4 versus 0.1±0.4 (cardiologists, P=0.88), and 0.2±0.9 versus 0.4±1.7 (other specialists, P=0.12) in HNC and UC, respectively.

Authors {Angermann et al, 2012},  showed non-significant difference for GPs visits as well: across the entire study population, mean contact frequencies with GPs (home and office visits) were 13.5±10.6 in HNC and 12.9±11.1 in UC, respectively (P=0.46). Average numbers of contacts per patient month alive, out of hospital, and under observation were 2.4±1.8 versus 2.4±2.1 (GP p=0.82), 0.1±0.4 versus 0.1±0.4 in HNC and UC, respectively.

Krum et al, 2013, during 12 months period, showed that patients in the usual care group visited their general practitioner more frequently compared with those in UC + intervention group (12.55 GP visits/patient [UC] vs. 5.85 GP visits/patient [UC + I]). Reduction in the utilization of general practitioners, with the control group visiting their general practitioner more than twice as often as the intervention group, may be due to compliance (in 65%) with the automated telephone support system in the intervention group, reducing the need for participants in the intervention group to visit their general practitioner.

Details could be found in Appendix 4.

Important
Partially
Huic M et al. Result Card EFF6b In: Huic M et al. Clinical Effectiveness In: Jefferson T, Cerbo M, Vicari N [eds.]. Structured telephone support (STS) for adult patients with chronic heart failure [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali ; 2015. [cited 10 June 2023]. Available from: http://corehta.info/ViewCover.aspx?id=305

Does Structured telephone support (STS) impact on the primary care visit rate (disease-specific) of adults with chronic heart failure, compared to standard care without Structured telephone support (STS)?

Authors: Mirjana Huic, Pernilla Östlund, Romana Tandara Hacek, Jelena Barbaric, Marius Ciutan, Cristina Mototolea, Silvia Gabriela Scintee

Internal reviewers: J. Puñal, J. Gonzalez-Enriquez, H. Stürzlinger, A. Lo Scalzo, S. Maltoni

Acknowledgments: We would like to thank Ms Ana Utrobičić, MLIS, the Head of the Central Medical Library at the University of Split School of Medicine, Split, Croatia for development of systematic literature search strategy and performed search on standard medical and HTA databases.

The same methodology was used as described in section for the whole domain.

Assessment element questions EFF6b and EFF6c, based on assessment element: D0023, were answered together, please see above.

Important
Partially
Huic M et al. Result Card EFF6c In: Huic M et al. Clinical Effectiveness In: Jefferson T, Cerbo M, Vicari N [eds.]. Structured telephone support (STS) for adult patients with chronic heart failure [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali ; 2015. [cited 10 June 2023]. Available from: http://corehta.info/ViewCover.aspx?id=305

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